Role of frozen section analysis of testicular/paratesticular fibrous pseudotumours: a five-case experience

Abstract

Background: Fibrous pseudotumours of the testicular and paratesticular tissues are fibroinflammatory reactive lesions that can clinically mimic neoplasms. Very little is known about the role of frozen section analysis (FSA) for these lesions in terms of intraoperative surgical management. Methods: We recently experienced 5 patients with testicular/paratesticular fibrous pseudotumours in whom frozen sections were used to demonstrate its non-neoplastic nature prior to the decision for radical surgery. Results: In 2 cases, FSA resulted in testicular-sparing surgery. In contrast, the remaining 3 cases ultimately underwent radical orchiectomy, due to questionable viability of the testicle involved by inflammatory/infiltrative lesions and in 1 case a slight possibility of lymphoproliferative malignancy. Conclusion: Urologists should be aware of this entity and its gross features, such as firm masses and diffuse fibrous proliferation encasing the testicle to help determine intraoperative management. In select cases, intraoperative FSA is helpful in obviating radical orchiectomy.

Pediatric fibrous pseudotumor of the tunica vaginalis testis

“…Intraoperative consultation is helpful in guiding the most appropriate management at the time of surgery. However, definitive diagnosis of paratesticular fibrous pseudotumor at the time of frozen section is challenging and often only a descriptive diagnosis is rendered [14] . Historically, the diagnosis of fibrous pseudotumor was usually established after radical orchiectomy.…”

Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought?

“…Of the 43 cases with non‐malignant FSA diagnosis, seven (16.3%) underwent radical orchiectomy mainly because of clinical suspicion for malignancy. Three of the seven cases undergoing orchiectomy despite non‐neoplastic or benign diagnosis had fibrous pseudotumor, which is believed to be a reactive lesion, but clinically mimics a malignant neoplasm, because of questionable testicular function and/or a history of severe pain . Overall, in our study, radical orchiectomy was successfully avoided in 36 (83.7%) of 43 cases with benign FSA in addition to three cases of lymphoma.…”

Paratesticular fibrous pseudotumour: Intraoperative frozen section analysis can help prevent unnecessary orchiectomy

“…6,8,16 Intra-operative frozen section analysis (FSA) may provide a means for testicle-sparing surgery in patients with PFP, although it may be difficult to definitively rule out malignancy with a limited sample. 4,16 In some cases, diffuse tunica involvement complicates surgery, which may preclude sparing the testicle. …”

“…They frequently involve the tunica vaginalis, with rarer cases arising from the tunica albuginea, epididymis and spermatic cord. [1][2][3][4][5][6] Peak incidence occurs in the third decade of life, but reports exist in all age groups. 7 Although patients may report a history of testicular trauma, infection or hydrocele, the similarity in presentation to malignancy often results in radical surgery with diagnosis made on the resected specimen.…”